Which States Are Most IMG-Friendly?

When applying for residency, especially as an international medical graduate (IMG), it is important to apply broadly beyond the state or region that you want to end up, to maximize your chances at getting interviews and matching. Looking at the number of IMGs that match into residency in different states, it is clear that some states are more IMG-friendly than others. When applying for residency, consider applying to these IMG-friendly states, as you’ll have a better chance at getting interview invitations from them. Here, I took the latest 2013 NRMP match data and compiled a ranking of states according to the percentage of newly matched residents who were IMGs in 2013.

Disclaimer: Within states, IMG-friendliness may also vary according to specialty, as some specialties (like family medicine or internal medicine) tend to be more IMG-friendly than others (not a lot of IMGs in orthopedic surgery). Here, I am addressing the IMG-friendliness of states as a whole, regardless of specialty. I define IMG as including both US IMGs as well as foreign IMGs.

The most IMG-friendly state is by far New Jersey, where more than half of the newly matched residents were IMGs. States like Wyoming and North Dakota are also IMG-friendly, but they don’t have that many residency positions available. Other very IMG-friendly states include Michigan and New York. Here are some more details that I used to create the above chart:

State

Total Matched

US IMG

Foreign IMG

% IMG

New Jersey

769

238

193

56.0%

Wyoming

12

5

1

50.0%

North Dakota

44

3

17

45.5%

Nevada

110

35

11

41.8%

Michigan

1184

180

302

40.7%

New York

3642

559

738

35.6%

Oklahoma

206

33

35

33.0%

Connecticut

586

84

101

31.6%

Arkansas

175

31

24

31.4%

Ohio

1402

145

275

30.0%

West Virginia

169

15

35

29.6%

Florida

880

100

144

27.7%

Georgia

515

75

63

26.8%

Hawaii

71

9

10

26.8%

Arizona

445

68

50

26.5%

Louisiana

497

87

44

26.4%

DC

427

17

91

25.3%

Illinois

1593

157

241

25.0%

Nebraska

173

10

33

24.9%

Mississippi

122

16

14

24.6%

Maryland

623

41

112

24.6%

Pennsylvania

1795

163

261

23.6%

Kansas

195

23

22

23.1%

Kentucky

295

35

32

22.7%

Montana

18

3

1

22.2%

Alabama

341

26

49

22.0%

Iowa

220

13

34

21.4%

South Dakota

38

3

5

21.1%

Texas

1682

130

191

19.1%

Puerto Rico

185

32

3

18.9%

Tennessee

518

52

44

18.5%

New Mexico

141

8

18

18.4%

Virginia

511

66

27

18.2%

Rhode Island

190

8

24

16.8%

Minnesota

503

21

62

16.5%

Missouri

619

26

70

15.5%

Indiana

377

28

26

14.3%

Maine

77

8

2

13.0%

Wisconsin

458

27

28

12.0%

Vermont

67

7

1

11.9%

Idaho

34

4

0

11.8%

New Hampshire

84

4

5

10.7%

North Carolina

712

41

33

10.4%

Massachusetts

1323

57

67

9.4%

California

2593

138

92

8.9%

South Carolina

324

17

7

7.4%

Delaware

68

3

2

7.4%

Oregon

220

2

13

6.8%

Washington

388

11

10

5.4%

Utah

187

3

6

4.8%

Colorado

313

6

3

2.9%

Alaska

9

0

0

0.0%

Total

28130

2873

3672

23.3%

What should you get out of this?

If you are an IMG and your dream is to match in not-so-IMG-friendly states like Colorado or Utah, you can definitely try applying to these states. Perhaps you’ll be one of of the few lucky IMGs who match there. However, don’t put all your eggs in one basket. Apply to other states that are more IMG-friendly so that you’ll increase your chances of matching.

I was wondering if you have any comments or knowledge on the decrease in residency positions that IMGs will be able to secure in the near future? I’ve read on several forums (SDN, etc…) that with the rise in US medical schools and expansion of seats at US med schools, IMGs will be “bottle-necked” out of US residency positions due to preferential treatment given to US students.

Hi Steven,
It is true that US med schools are expanding enrollment. I was looking at some of the statistics that the AAMC put out. There were 287 more US medical students in 2012 than there were in 2011. There were 538 more students in 2013 than there were in 2012. However, at the same time, residency spots available in the Main Match have also been steadily increasing. 613 more residency positions were added in 2012 (to a total of 24,034 positions), and 2358 more positions were added in 2013 (to a total of 26,392 positions). This sudden increase in number of residency positions in the Main Match in 2013 was probably due to the implementation of the “All-In Policy” in which residency programs have to either fill all their available positions through the Main Match or fill all their positions via Pre-Match (which is only available to IMGs like us). The result is that many of the programs that used to do half Main Match and half Pre-Match decided to fill all their positions through the Match while a minority of other residency programs decided to withdraw completely from participating in the Main Match and do Pre-Match exclusively to fill their residency positions. While it is great for IMGs that there are now more positions in the Main Match than before, it also means there are less positions for IMGs who may want to Pre-Match.

So given the statistics at the moment, while med school enrollment is increasing (both in the US and in the Caribbean), the number of residency positions are also increasing at the same time. I think it’s hard to say now what the future will be like for IMGs. There may be other factors that I may not be thinking of right now, and federal funding for residency programs as well as policies may change within the next few years. But given the statistical trends I see for the past few years, I think (and I hope) that there won’t be any drastic changes in the matching chances for IMGs in the next few years.
Benji

I am confused. I am Canadian citizen. Currently I am in school of Pharmacy(2nd yr).I am not accepted this year by any of three med schools I applied in Ontario(These schools allow you to apply if you have taken required courses and have finished 3/4 years of university education. I can’t apply other schools in Canada and US as they require bachelor degree ).

I have following options:

1. I can try again with those 3 schools next year
2. Finish my Pharmacy graduation, I can then apply many Canadian and US schools (But that’s two years from now)
3. Take Caribbean route this year and save two years and debt made for studying next two years of Pharmacy

But if I choose fourth option,

1. How about US clinical rotation if in Caribbean school? I believe Caribbean schools arrange it for you. Is it true?
2. Is it not uphill battle when it comes to be accepted for residency in US?
3. I come across some really scary stories of IMGs not getting residency. This(http://thescurlockscene.blogspot.ca/2014/03/the-match-soap-reality-of-being-img.html) is the story of a St. George graduate
4. What happens with those IMGs who are not getting any residency? They have to wait an year and try again?
5.What Caribbean schools would you recommend? People say these four (st. George,Ross,AUC and Saba) are top schools.
5. Finally is it worth taking that Caribbean route in the case like mine?

I recommend finish schooling, then apply. Med schools in the US, Canada, and the top four schools in the Caribbean all require at least a bachelor’s degree. Residencies in the US may look at not having a bachelor’s degree as a red flag when they compare candidates. Don’t try to save the money… It’s not worth the risk of going the cheap or quick route when it comes to your education.

You post a lot of questions. Please do a search through my blog. You may find a lot of answers you are looking for in my posts.

Hi Ash, thanks for reading my blog. I would highly recommend finishing at least a bachelor’s degree before med school because you will need that academic experience to feel better prepared for the challenge that is med school. Also many residencies may see not having a Bachelor’s degree as being a red flag. To increase your chances to match in the US, I recommend trying to do your education as similar as possible to what you would do in the US.
Benji

Very interesting information. My husband is a 2014 graduate of SGU. He did not match or SOAP into a spot in the 2014 Match but was able to find a preliminary position post-SOAP at the University of Massachusetts. He did, however, match categorical surgery there this year in the 2015 Match. The information on your blog is great and much needed for any medical student, especially an IMG. I write a blog too (though not predominately medicine based) but I wrote about our Match process here. http://thescurlockscene.blogspot.com/2014/03/the-match-soap-reality-of-being-img.html

Thanks for sharing Stephanie,
IMGs definitely have a lot of obstacles to go through and I am so glad to hear that your husband matched into categorical surgery this year! All the best to your beautiful family.
Benji

Thanks for taking out your time and posting in this blog. It is very useful.
Im attending Avaoln University School of Medicine (One of the Caribbean Schools). I will finish m core rotations next week. I want to apply for electives in different hospitals, because I finished all my cores in Beckley WV, which is not green book. Would you tell me which schools/hospitals do I need to apply for my electives in order to have a better chance in residency?

Hi Sweeja,
I cannot tell you every single place that is greenbook. There are too many and I do not know them all. You will have to do some research on the ACGME website to look for hospitals that have residency/fellowship programs. Then you have to contact the programs individually to see if they offer rotations for med students. Or better yet, contact your school to see where other students have done rotations before.
Benji

Why would anyone want to go anywhere? I am not from Utah or Colorado but I can probably think of a million reasons. The biggest reason I would imagine anyone wanting to be somewhere is to be close to family and friends. That’s a big reason why I decided to move back to Georgia. People may also like the program that the residency or job offers. Maybe it’s cost of living or standard of living. Maybe it’s the education system, or the churches, or the livability of cities like Salt Lake City or Denver. Perhaps people love hiking, nature, or winter sports.

Hi Benji,
Where do you think the old graduate IMGs should apply in term of specialties, where I heard that even Family medicine is getting more popular among the US graduated, anther question do you recommend taking the risk of time adn money to do PTAL to apply to California.
Thanks

I’m not sure if I understand your question. I recommend applying to the specialty you want to pursue, and making your best effort to make that happen, including knowing your target exam scores and exceeding them, joining professional societies of your desired specialty, doing electives and getting letters of recommendation from your desired specialty. Write a killer personal essay expressing your passion and commitment to that specialty. As someone who is passionate about Family Medicine, I don’t recommend my specialty for everyone, and certainly not every IMG. I want my specialty to be practiced by people who are truly dedicated and passionate about the field of Family Medicine, and I want to work with colleagues who truly love what they do and do what they love. While I agree that if you desire to apply to a very competitive specialty such as radiology or neurosurgery, you should have a backup. But please choose a backup that you at least would enjoy. It’s not pleasant working with people who don’t enjoy what they do. As for California, apply if you have the desire to end up there. Otherwise there are plenty of states that are more IMG-friendly that you can apply to without a special time consuming expensive application.

Hello, this graph is very informative and I appreciate the information. I am currently a 2nd year medical student, attending a medical school program that is based out of the Caribbean but has satellite campuses in the US. I am currently a PA by profession, and have been working as a PA since 2008. I have served in the US Army as a physician assistant, and I am currently working at a cancer center in Arizona while attending school. I know that the competition for IMGs to get “matched” is higher; however, do you feel that working as a medical provider in the states provides a pretty good advantage to get into a residency program?

I think it may help, or at least make you stand out. However, you have to make sure that your USMLE scores, grades, and letters of recommendations are still excellent and on par with your fellow med students, no matter whether or not they have had previously clinical work experience. Having experience as a PA or another type of medical provider does not make up for bad scores or grades. I have seen this first hand with classmates who used to be PAs and NPs.

Hello .
My name is Mihaela, I finished med. school in Romania in 2012,I was on maternity leave a period, than I just finished 1 year of Obstetrics and Gyne..
What are my chances to get into a residency program,I want internal med. or family me.?
And can I get suggestions on study material for Step 1 and 2.
Thank you a lot.

Hello.
I am img class 2005 and I finished my residency on Ob/gyn,now I am married and have 2kids and live in us…what is my apportinity to be matched to a residency program( regardless if it is on ob/gyn or other programes)..I have one failed attemp on step 1 due to unproper preparation ..finally I am a citizen does that matters?? I realy need your advice.
thank you alot
thank you alot

Hi Rana,
I assume you finished your OBGYN residency in another country. Being a citizen definitely helps. However, your chances depends on how good your application is. I’m sorry to hear you failed Step 1. Unfortunately that is a big red flag. You will have to pass Step 1 and 2CS and 2CK. You will need to have an ECFMG certificate. First and foremost, however, I highly recommend you improve your English, or at least your writing skills. You will need to be proficient in English to pass the Step 2 CS, write a good personal statement, and to make a good impression among residency programs, as well as work with patients effectively.
Benji

Hi. Love your blog!
I am an IMG graduated in 2012. Does year of graduation affect my application and what residency programs and specialty overlook year of graduation? Planning to match in 2017. Thanks

I’m a US-IMG, graduated from a non-top 4 Caribbean school in 2014. I completed all of my rotations in Chicago. Scores were (189)/CK(209-2nd attempt/CS (Pass). I applied for FM this match and was unsuccessful. I know my scores are my downfall. I’ve tried numerous times to obtain research and/or externships to help improve my application, but cannot seem to secure any. Do you have any recommendations for next year?

Hi Benji, first of all thank you for your Blog! I am a US Resident but i graduated from medical school in the UK in 2010 and have been working in internal medicine and Dermatology since in the UK. I am moving back to the US to be nearer family and I want to apply to a Family Medicine Residency program. I have heard lots of confliciting information, I have yet to take my USMLE step 1 but plan to do so this Fall as I know i need great scores. I am worried about my chances of getting into a residency program since I graduated in 2010. Do you think I have any chance? ( i know a lot of this depends on my USMLE scores).

Hi Benji, I am a non-US IMG. My score for USMLE are 218, 230, pass, so because my score are not high enough for getting into residency (internal medicine) in the US I am thinking to apply into Caribbean residency programs but I even dont know if there any. Please if you have any information about Caribbean residency programs or may be website or you have recommendation, I appreciate any help. Thank you

Hi Juscuevo, Sorry to hear that you did not match. I do not know of any residency programs in the Caribbean. Your scores are decent. I would try applying again to more programs and to more specialties in the US. If you do residency in another country, you will not be able to practice medicine in the US, unless you do residency in the US.

Hi Benji
Thanks for your very informative graphs .To me it was really helpful and i really appreciate that.I was wondering if you could possibly help me .I’m a 3rd year med student from Iran and I’d really like to continue my education there,ie applying for residency.Since I’m not a permanent US citizen ,will be some more sever limitations for me in both IMG friendly and non-IMG friendly states?my second question is about USMLE score?what is the average acceptence score for an IMG to be applied for IM,ped,OB/GYN and Dermatology? According to what you said above,it’s impossible right now to judge about what would happen in the coming years.But is it really possible for the IMGs to be applied at a higher rink with this more schools opening?I mean more med schools may bring more chance to apply .Although the federal and tuitions may change as well.

Thank you so much for all the info that you have provided. I am a third year medical student from UMHS St. Kitts (Caribbean medical school) and am waiting to be placed in rotations. My Step 1 did not work out how I wanted it to. After studying like crazy I only managed to get a 218 and now Im terrified that I wont be able to match at all. I wanted to go into gen surgery since forever but now I feel like I will have to choose something that is within my range. What are the chances that I will match? Or what else do I need to do to make sure I can match.

Jiftikh, 218 is not bad at all! However, if you are concerned, remember you still have Step 2 to prove your worth. Work hard and show enthusiasm during all of your rotations so you get good clinical evaluations. Programs look at all of these and not just your Step 1 score.

Hi Benji, could you give more information about what specific programs have the highest rates of matching IMGs (within New Jersey or other states)? Or where I could find the information? I’m not sure if NRMP has it anymore. Thanks.

Hi Paige, residency program directors would probably recognize the big Caribbean schools more (AUC, Ross, SGU, Saba, AUA), and therefore feel more comfortable inviting these schools’ graduates for interviews. However, your likelihood of matching is more than just which international med school you go to. It’s much more about your USMLE scores, grades, recommendations, etc.